Vomer-Rostrum Mucosal Flap for Exposed Bone Coverage After Sphenoid Sinusotomy.

The vomer-rostrum mucosal flap is a useful technique utilizing vascularized mucosa of the rostrum and posterior septum to cover exposed hyperostotic bone following wide sphenoidotomy surgery. Laryngoscope, 133:552-556, 2023.

Triple Layer Oronasal Fistula Repair Using Local Endonasal Flaps: Case Series of Three Patients.

Oronasal fistula (ONF) is a common complication encountered after palatoplasty. Repair is indicated when symptoms impact speech and swallowing. In spite of the variety of surgical approaches described to repair these defects, recurrence rates remain high. Traditionally, successful closure is said to be achieved in using a double-layered approach due to the three-dimensional aspect of the defect. The extent of the fistula into the nasal cavity has incited an increased curiosity in using local endonasal flaps. In recent years, endonasal reconstructive procedures have seen increased interest and application, from cranial base defect repairs to orbital reconstruction and beyond. The nasoseptal (NSF) and inferior turbinate flaps (ITF) possess a robust arterial supply and an exceptional reach with excellent results demonstrated in large defect repair. However, the use of these flaps in ONF repair is scarcely discussed in the literature, and their effectiveness is relatively undetermined. In this manuscript, we present a series of three patients who underwent a triple layer ONF closure, with the oral portion incorporating a turn-in mucosal flap plus a local palate rotation flap or greater palatine artery pedicled-rotation flap, and a NSF or an ITF for the nasal portion of the defect.

Cochlear Implantation After Intralabyrinthine Schwannoma Microsurgical Resection.

ABSTRACT: Cochlear implantation after microsurgical resection of intralabyrinthine schwannomas has shown promising results in a limited number of small studies with safe and favorable outcomes. Cochlear implantation is a mainstream treatment for advanced bilateral sensorineural hearing loss and, more recently, has been applied to patients with single-sided deafness.The case presented is a 66-year-old gentleman with a history of progressive right-sided sensorineural hearing loss and bothersome tinnitus with a right intralabyrinthine schwannoma involving the semicircular canals, vestibule, and basal turn of the cochlea. The authors describe concomitant cochlear implantation after microsurgical resection of an intralabyrinthine schwannoma. Intralabyrinthine schwannomas represent an uncommon subtype of benign tumors arising from the terminal branches of the vestibulocochlear nerve. Symptoms often include sensorineural hearing loss, dizziness, and tinnitus, and in this location, symptoms often arise at a small tumor size. In this featured case, we present a patient who underwent gross total tumor resection and cochlear implantation for hearing rehabilitation and treatment of tinnitus. Six months after surgery, the patient achieved good device performance, scoring 46% on consonant-nucleus-consonant word testing and 66% on AzBio sentence testing, and subjective improvement in his tinnitus.

Real-Time Dual Video Conferencing of Simulated Tracheostoma Maturation During Residency Interviews.

Background: There are few reports of dexterity tests being done in a distance telecommunication setting for residency applicant evaluation. Objective: To report the feasibility and suitability of a virtual suturing skills assessment during residency interviews when added to the standard assessment process. Methods: A suturing simulation was developed and implemented during otolaryngology-head and neck surgery (OHNS) residency interviews for the 2020-2021 cycle at one program. On the day of the interview, the activity was completed in real time using 2-camera video conferencing with the 2 resident assessors providing a numerical assessment based on an adapted scoring rubric from prior suturing activities at the institution. The exercise involved suturing a 3/4-inch Penrose drain circumferentially with half-vertical mattress stitches to simulate the maturation of a tracheostoma. The residency selection committee then completed a 7-item Likert-type survey, developed by the authors, to evaluate the simulation exercise. Results: Fifty-one applicants representing all interviewees in the cycle successfully completed this assessment without technologic disruptions. The total cost associated with obtaining and providing the necessary supplies to applicants was $34.78 per interviewee. Time required to complete the suturing task was estimated to range from 10 to 20 minutes. The residency selection committee viewed this exercise as a success (14 of 16, 87.5%) and viewed the results as a valuable adjunct in the overall assessment of candidates (15 of 16, 93.8%). Conclusions: A simple motor exercise completed over real-time telecommunication was feasible and perceived as helpful to the residency selection committee when assessing OHNS residency candidates.

The Posterior Septal Nasal Floor Mucosal Flap for Cranial Base Reconstruction.

OBJECTIVE: While pedicled intranasal flaps, such as the nasoseptal flap (NSF), successfully reduce postoperative CSF leaks following endoscopic endonasal approaches (EEA) to the skull base, morbidity remains prevalent. This study describes the first cadaveric description and radiographic analysis of the posterior septal nasal floor mucosal flap (PSNF) designed to reduce pedicled nasal flap morbidity. A case series is also detailed. STUDY DESIGN: Cadaveric dissection, radiographic analysis, and case series. METHODS: Seven cadaver specimens underwent harvest of the PSNF. PSNF flap dimensions were measured on the thirty deidentified sinus computed tomography (CT) scans. A retrospective case series was performed on the first set of patients who received the PSNF for reconstruction of a sellar base defect. Information concerning complications, symptoms, and the appearance of the flap was recorded from records of the patient's postoperative inpatient stay, 1-week postop visit, and 1-month postop visit. RESULTS: Cadaver dissection of the PSNF flap demonstrated good arc rotation along its pedicle with ability to cover both sellar and planum defects. Cadaveric flap measurements and CT-derived measurements estimated a mean surface area of 16.7 and 18.3 cm2 , respectively. 15 patients underwent reconstruction of a sellar or planum defect using the PSNF technique. Only one CSF leak was encountered postoperatively. Minimal crusting of the flap and donor site was seen 1 month postoperatively. CONCLUSION: The PSNF flap provides a sizeable pedicled region for reconstruction comparable to other pedicled nasal flaps. Our case series demonstrated good postoperative outcomes without reduced donor site morbidity. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:1561-1568, 2022.

Tympanic Membrane Pneumatocele from Auto-insufflation.

OBJECTIVE: The differential of an external auditory canal mass is broad. One rare potential cause is a pneumatocele of the tympanic membrane, which has only been described 1 other time in the literature. This report serves to describe the second case of this pathology, including its unique presentation, and benign clinical course. METHODS: Case report. RESULTS: A case is discussed in which a pneumatocele of the tympanic membrane was incidentally identified during evaluation of contralateral otologic pathology. The etiology was suspected to be habitual auto-insufflation. After cessation of this practice, the pneumatocele was noted to resolve without further intervention. CONCLUSION: A tympanic membrane pneumatocele represents a rare cause of an external auditory canal mass. The diagnosis can be made clinically via history, palpation, and otoscopy during auto-insufflation, potentially avoiding further diagnostic testing. Depending on the etiology, resolution can occur after lifestyle modification; however, further interventions may definitively treat the condition if so required.

Treatment of Lateral Skull Base and Posterior Cranial Fossa Lesions Utilizing the Extended Middle Cranial Fossa Approach.

OBJECTIVE: Define the indications and outcomes for subjects undergoing treatment utilizing the extended middle cranial fossa approach (EMCF). STUDY DESIGN: Retrospective records review. SETTING: University-based tertiary referral center. PATIENTS: Subjects undergoing treatment of posterior cranial fossa (PCF) lesions. INTERVENTION(S): EMCF exposure and treatment of the indicating PCF lesion. MAIN OUTCOME MEASURE(S): Demographic, audiometric, and cranial nerve functioning variables were assessed. RESULTS: Thirty-five subjects who underwent an EMCF exposure were identified over a 12-year period. The most common indication was meningioma (18; 51%) followed by schwannomas (six, 17%), and vascular lesions (five, 14%). Preoperative cranial nerve complaints were common (32, 94%) as were objective cranial nerve abnormalities on physical examination (21; 60%). Preoperative audiometric data from subjects with hearing demonstrated good functioning including pure-tone average (PTA) (21.7 ±â€Š15.6 dB HL) and word understanding scores (95.1 ±â€Š7.4%). Most (34, 97%) subjects had intact facial nerve function. The average length of stay was 11.6 days (median = 9). Cranial neuropathies were common postoperatively with 27 (79%) subjects demonstrating some objective cranial nerve dysfunction, the most common of which was trigeminal nerve hypesthesia (21, 61.7%). Subjects with identifiable pre- and postoperative audiometric data and preoperative hearing demonstrated small declines in the four-tone average (16.2 dB) and word recognition scores (22.4%). Two subjects (6%) had new profound hearing loss postoperatively. CONCLUSIONS: The EMCF approach can provide safe and effective exposure of the anterior PCF.